Antipsychotic Drugs in Nursing Homes in Baltimore

What are Antipsychotics?

Antipsychotics are a particular class of prescription medication which are used to treat conditions that involve psychosis. They are usually prescribed to those with schizophrenia, bipolar disorder, extreme paranoia, and/or hallucinations. However, as the use of antipsychotics grows, many institutions are now using the drugs for new purposes, such as the treatment of anxiety, prolonged nausea, vertigo, violent behavior, and the agitation and confusion associated with dementia. Since many of these symptoms become worse with age, unfortunately, nursing homes may use antipsychotic medications to subdue their residents and make them easier to manage. This practice is illegal and dangerous to elderly individuals who are subjected to severe risks and side effects from the unnecessary ingestion of antipsychotics drugs.

The Problem

Millions of elderly individuals are being given antipsychotic drugs to reduce the symptoms of Alzheimer's and dementia, as well as to neutralize aggressive tendencies. A study completed in 2010 showed that 39.4% of nursing home residents with some form of cognitive impairment were given antipsychotic medication. As of 2007, research has shown that, while 25% of nursing home residents receive antipsychotics, only about 7% of residents have an approved diagnosis, which means that many elderly people are being given the drug “off-label.” Off-label refers to the practice of prescribing or administering drugs to people to treat conditions or behaviors which have not been evaluated by the FDA. The drugs are not, therefore, tested for safety and effectiveness on the particular medical condition for which they are being used.

Antipsychotics as a Chemical Restraint

One of the most sinister and destructive methods of using antipsychotics is as a chemical restraint. Chemical restraint refers to the use of medicine of any kind to subdue or sedate an unruly patient. Nursing homes are permitted to use chemical (or physical) restraints if the resident is posing a direct threat to him or herself or to a staff person. If the resident is being particularly violent or aggressive, or if they have lost the ability to control themselves, chemical restraints may be necessary.

Often, however, nursing home staff decide to use chemical restraints in situations where they are not necessary, exposing elderly patients to the substantial risks of a highly potent and not fully understood drug.

Side Effects of Antipsychotics

There are many severe consequences to the non-prescribed or unnecessary use of antipsychotics, especially in the vulnerable elderly community. Most alarmingly, the Food and Drug Administration issued a “Black Box” warning in 2005 about prescribing antipsychotic medications to elderly people with dementia because it can be fatal in that population. Paradoxically, elderly individuals with dementia are prescribed antipsychotics much more frequently than other residents, often because their behavior takes more time, patience, and staff to manage without the use of antipsychotics. In fact, up to 88% of antipsychotic drugs are used on patients who have some level of dementia. It may be “easier” to use antipsychotics than to spend time and energy working with a patient to calm feelings of anxiety or aggression. Besides the fatal risks involved, there are also other severe side effects of antipsychotic drugs.

Increased Rate of Falls

Residents in nursing homes who are given antipsychotics are more likely to experience falls, which can be fatal in the elderly population. In fact, one study published in the The Journal of Post-Acute and Long-Term Care Medicine found that nursing home residents who were given antipsychotics were around three times more likely to experience falls.

Decreased Quality of Life

If antipsychotics are prescribed or administered without a proper cause, they can have dramatic interactions with the individual's normal psychology. They can cause a resident to become listless and unresponsive, and keep them from participating in normal everyday activities such as social groups or spending time outside.

Other Health Concerns

In general, elderly individuals experience the side effects of antipsychotic drugs more strongly than young people, and the medication can contribute to serious health problems, including

  • Decreased heart function or heart attack,
  • Problems with coordination, movement, comprehension, and awareness
  • Choking, infections, and pneumonia
  • Akathisia, a feeling of restlessness that looks like anxiety or agitation
  • Constipation, dry mouth, blurred vision, and urine retention
  • Weight gain and diabetes

Because of the severity of these side effects, antipsychotic drugs, in particular, must be selected intentionally and with due care, considering the patient's medical history, current medical issues, and other medications that may cause adverse interactions with the drug.

Know Your Loved One's Rights

If your loved one is exhibiting any of the preceding symptoms, you may want to examine the possibility that they are being given unnecessary antipsychotics. Federal law dictates that nursing home residents have the right to be free from unnecessary medication. Although the line between necessary and unnecessary can be tricky, residents should not be given antipsychotics

  • In excessive dosages or for excessive periods of time
  • Without a clear medical purpose
  • Without adequate monitoring
  • That may cause severe adverse effects or interactions

In fact, federal statutes state that antipsychotic drugs must be regulated through a comprehensive assessment of a resident so that:

  • (i) Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and
  • (ii) Residents who use antipsychotic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.

Residents also have a right to be informed about their medications and any changes in drug regimens that are made by doctors or staff.

Nursing Home Abuse Attorney

Watching a loved one suffer from the effects of unnecessary medication can be maddening, especially when it causes a serious health concern or death. Antipsychotics should be used exclusively according to a medical professional's prescription. If you believe that your loved one was exposed to antipsychotic medication without their consent or the explicit advice of a doctor, you may want to consider legal action. For a free case evaluation, call trial attorneys Charles Gilman and Briggs Bedigian today at 800.529.6162 or contact them online.

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